Unitary blood vessel dissector and harvester device

ABSTRACT

A unitary dissector/harvester device for dissecting and harvesting a vessel has an elongated dissector tool for insertion into a body having the vessel to be harvested and a harvester tool axially positioned within the dissector tool.

CROSS-REFERENCE TO RELATED APPLICATIONS

Not applicable.

STATEMENT REGARDING SPONSORED RESEARCH

Not applicable.

BACKGROUND OF THE INVENTION

The present invention relates to the harvesting of blood vessels and,more particularly, to a method and apparatus for endoscopic dissectionand retraction of sections of blood vessels for use as a coronary arterybypass graft.

In connection with coronary artery bypass grafting (CABG), a bloodvessel or vessel section, such as an artery or vein, is “harvested”(i.e., removed) from its natural location in a patient's body and isused elsewhere in the body. In CABG surgery, the blood vessel is used toform a bypass between an arterial blood source and the coronary arterythat is to be bypassed. Among the preferred sources for the vessels tobe used as the bypass graft are the saphenous vein in the leg and theradial artery in the arm.

Endoscopic surgical procedures for harvesting a section of a bloodvessel (e.g., the saphenous vein) subcutaneously have been developed inorder to avoid disadvantages and potential complications of harvestingof the blood vessel. In the past, the harvesting was done through acontinuous incision (e.g., along the leg) which exposed the full lengthof the desired vein section. The continuous incision had been necessaryin order to provide adequate exposure for visualizing the vein and forintroducing the surgical instruments to sever, cauterize and ligate thetissue and side branches of the vessel.

A more recent development has been a minimally-invasive technique thatemploys a small incision for locating the desired vessel and forintroducing one or more endoscopic devices into the small incision. Thefirst step was the primary dissection of the vessel in order to separatethe vessel from surrounding tissues within the patient's body. Theprimary dissection of the vessel occurred by introduction of adissecting instrument through the small incision to create a workingcavity (i.e., a “tunnel” around all sides of the vessel) and to separatethe vessel from the surrounding tissue. The dissecting instrument wasthen removed from the patient's body.

The second step was the removal, or harvesting of the vessel from thepatient's body. The harvesting of the vessel occurred by introduction ofa cutting instrument into the working cavity to sever the blood vesselfrom the connective tissue surrounding the vessel. The harvestingincluded severing the proximal and distal ends of the harvested vesseland the severing of all the side branches extending from the harvestedblood vessel. The branches were then clipped and/or cauterized.

In one typical procedure, a first incision is made as the endoscopicentry site. The first incision is often located near a midpoint of thevessel being harvested, with the dissection of the vessel and thecutting of branches proceeding in both directions along the vessel fromthe entry site. In order to remove the desired section of the bloodvessel, a second small incision, or stab wound, is made at one endthereof and the blood vessel section is ligated. A third small incisionis made at the other end of the blood vessel section which is thenligated, thereby allowing the desired section to be completely removedthrough the first incision. Alternatively, only the first two incisionsmay be necessary if the length of the endoscopic device is sufficient toobtain the desired length of the blood vessel while working in only onedirection along the vessel from the entry point.

Commercially available products for performing the endoscopic bloodvessel harvesting procedure described above include the dissector deviceand the harvesting device which are sold together as the “VirtuoSaph™Endoscopic Vein Harvesting System” from Terumo Cardiovascular SystemsCorporation of Ann Arbor, Mich. Endoscopic vein harvesting systems arealso shown in U.S. Pat. No. 6,660,016 to Lindsay, U.S. Pat. No.7,077,803 to Kasahara et al., U.S. patent application publication Nos.2005/0010242 and 2005/0192612 both in the name of Lindsay, and U.S.patent application publication numbers 2005/0154257A1, 2005/0159764A1,2005/0148817A1, 2005/0149094A1 in the name of Kasahara et al., all ofwhich are incorporated herein by reference in their entirety.

In the VirtuoSaph™ System and Kasahara et al. Pub. No. '764, anendoscope is used to visualize both the dissection and harvestingprocedures. The endoscope image is necessary for the operator to dissectthe peripheral tissue along the blood vessel.

It would be desirable to reduce the time and to simplify the proceduresfor both dissecting and harvesting of vessels.

SUMMARY OF THE INVENTION

A unitary endoscopic device for dissecting and harvesting a vessel hasan elongated dissector tool for insertion into a body having a vessel tobe harvested, and a harvester tool axially positioned within thedissector tool. In certain embodiments, the harvester tool is coaxiallydisplaced with respect to the dissector tool and the harvester tool isadvanced through a distal end of the dissector tool. In certain otherembodiments, the dissector tool is coaxially displaced with respect tothe harvester tool and the dissector tool is retracted along theharvester tool to expose a distal end of the harvester tool.

An endoscope is co-axially positioned within the dissector tool in orderto visualize the dissection and harvesting of the vessel.

The dissector tool includes a sheath having a dissector tip which isused for separating peripheral tissue from the vessel being harvested.In certain embodiments, the dissector tip is defined by an oblique planeextending through a distal end of the sheath. In other embodiments, thedissector tip has a conical shape that includes at least one opening toallow the harvester tool to be displaceable with respect the dissectortip.

A method of severing branches from a vessel during harvesting from abody includes inserting the endoscopic device into the body alongsidethe vessel, using the dissector tool to form a cavity substantiallysurrounding the vessel, and engaging the harvester tool to secure thevessel and to individually sever any branches attached to the vessel.

Various objects and advantages of this invention will become apparent tothose skilled in the art from the following detailed description of thepreferred embodiment, when read in light of the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded structure diagram showing an operation systemcomprising a unitary dissector/harvester device and an endoscopeapparatus useful with the unitary dissector/harvester device.

FIG. 2 is a top structure diagram of a distal end of a unitarydissector/harvester device showing a harvester tool in an open andextended position in a sheath, and showing a distal end of the dissectortool where a closure thereon is in phantom.

FIG. 3 is a perspective structure diagram of a distal end of adissector/harvester device showing a harvester tool in an extendedposition.

FIG. 3A is a perspective structure diagram of a distal end of adissector/harvester device showing a harvester tool in a closedposition.

FIG. 4 is a top structure diagram of a portion of a harvester V-cutter.

FIG. 5 is a cross-sectional structure diagram of a unitarydissector/harvester device.

FIG. 6 is a view taken along the line 6-6 in FIG. 5.

FIG. 7 is a perspective structure diagram of another embodiment of adistal end of a unitary dissector/harvester device showing a harvestertool in a closed and extended position in a dissector tool.

FIG. 8 is a side elevational structure diagram of the embodiment shownin FIG. 7, and showing, in phantom, a dissector tool and a harvestertool.

FIG. 9 is another perspective structure diagram of the distal end of theembodiment shown in FIGS. 7 and 8.

FIG. 10A is a side elevational structure diagram of another embodimentof a distal end of a unitary harvester/dissector device in a closedposition.

FIG. 10B is an end structure diagram of the harvester/dissector deviceshown in FIG. 10A.

FIG. 11A is a side elevational structure diagram of another embodimentof a distal end of a unitary harvester/dissector device in an openposition.

FIG. 11B is an end structure diagram of the harvester/dissector deviceshown in FIG. 11A.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 is a structure diagram showing the structure of an operationsystem 101 useful for the above-mentioned operation. In the embodimentshown, the operation system 101 generally includes a trocar 8, a unitarydissector/harvester device 10, and an endoscope 80. The unitarydissector/harvester device 10 includes a dissector tool 11 and aharvester tool 20, as further explained below.

The operation system 101 further includes a monitor 102 as a displaydevice; a camera control unit 103; a camera device 104; a light sourcedevice 105; a light guide cable 106; an electric knife device 107; and,a gas feed device 108.

One end of the light guide cable 106 is connected to a light guideconnector portion 82 of the endoscope 80. Another end of the light guidecable 106 is connected to the light source device 105. The light fromthe light source device 105 is supplied to the endoscope 80 via thelight guide cable 106 through which an optical fiber is inserted.

A subject is illuminated with light from a front end portion 81 of theendoscope 80. A camera head portion of the camera device 104 isconnected to an eyepiece portion 83 on a base end side of the endoscope80. The camera device 104 is connected to the camera control unit 103,and an image of the subject captured by the endoscope 80 is displayed onthe screen of the connected monitor 102.

In order to view the subject, an inserting portion 84 at the front end81 of the endoscope 80 is inserted in a proximal end of the unitarydissector/harvester device 10, as further explained below.

An insufflation tube 30 is connected to the gas feed device 108, and agas is fed from the gas feed device 108 to the insufflation tube 30 tothe unitary dissector/harvester device 10, as further explained below.

The unitary dissector/harvester device 10 has an electric cable 31 foroperatively connecting the unitary dissector/harvester device 10 to theelectric knife device 107.

Referring now in particular to the unitary dissector/harvester device10, the unitary dissector/harvester device 10 generally includes thedissector tool 11 and the coaxially aligned harvester tool 20, each ofwhich will be described separately in detail below.

The dissector tool 11 comprises an elongated sheath 111 having adissector tip 113 at its distal end. The sheath 111 defines an innerspace 115 for receiving the harvester tool 20 and the endoscope 80. Theendoscope 80 is removably positioned within the inner space 115. Aproximal end 114 of the sheath 111 is operatively connected to a handle14 and receives the endoscope 80, as further explained below.

At least a portion of the dissector tip 113 is transparent in order toallow visualization of the vessel and the surrounding tissue. Uponinserting the dissecting tool 11 under the patient's skin, it ispossible to obtain an image illuminated by the illuminating light fromthe front end portion 81 of the endoscope 80.

To begin the dissection procedure, the dissector tip 113 is insertedthrough the trocar 8 that has been positioned within an initial incisionin the patient. In operation, the dissector tip 113 is pressed into thetissues surrounding the vessel, thereby forming a tunnel or cavityaround the blood vessel. In certain embodiments, it is desired that thedissector tip 113 be pressed into the surrounding tissue generally alongthe direction of the vessel in order to separate the vessel fromadjacent tissue without damage to the surrounding tissue.

In certain embodiments, the insufflation tube 30 may be connected to asource of gas (e.g., CO₂) for filling the cavity adjacent the vessel asthe cavity is being formed. In such embodiments, the dissecting tool 11is airtightly connected to the handle 14. The dissector sheath 111 caninclude one or more discharge ports or holes 135, as shown in FIG. 3,that are in communication with the inner space 115. The gas escapingfrom the ports 135 allows the gas to enter the forming cavity and tokeep surrounding tissue from the unitary dissector/harvester device 10.

In the embodiment shown in FIGS. 1-3A and 5, the dissector sheath 111 iscylindrical-shaped at its proximal end near the handle 14. The dissectorsheath 111 has a pointed shape at the tip 113. For example, best shownin FIGS. 2 and 3, the dissector tip 113 has a leading edge 120 so thatan opening 122 at the distal end of the inner space 115 has an ovalshape. In the embodiment shown, the opening 122 is defined by an obliqueangle with respect to a plane defined by the longitudinally extendingaxis through the sheath 111. For example, the opening 122 can be at a45° angle with respect to the longitudinal axis; however, it is to beunderstood, that in other embodiments, the angle at which the opening122 is formed can be other than 45°.

Also, in certain embodiments, the dissector tool 11 can include a lid orclosure 124 that extends over the opening 122. In such embodiments, theclosure 124 is preferably transparent. The closure 124 can beoperatively secured to the sheath 111 in a suitable manner. In certainembodiments, the closure 124 can be secured to the sheath 111 by a hinge126. For example, a “living” hinge 126 can be formed on a trailing edge128 of the opening 122.

The dissector tool 11 is advanced through the patient's tissue, formingthe cavity or tunnel around the blood vessel. The dissector tip 113 isthus used to perform an initial, or blunt, dissection of the vessel.After the initial blunt dissection around the vein by the dissector tool11, the coaxially aligned harvester tool 20 is engaged to “harvest” (orremove) the bluntly dissected vessel. As further explained in detailbelow, the harvester tool 20 is used to grasp the vessel being dissectedand to sever any branches or connective tissue connecting to the vessel.

In the embodiment shown in FIGS. 1-3A and 5, the harvester tool 20 iscoaxially displaced with respect to the dissector tool 11. In certainembodiments, the harvester tool 20 is advanced through a distal end ofthe sheath 111. In the embodiment shown in FIGS. 1-3A and 5, theharvester tool 20 is advanced past the distal tip 113.

Referring now, in particular, to the harvester tool 20, the harvestertool 20 is coaxially aligned within the sheath 111 of the dissector tool11. The harvester tool 20 is operatively connected to the handle 14. Theharvester tool 20 includes a vessel keeper (V-keeper) 24 for retainingthe vessel being dissected and a vessel cutter (V-cutter) 25 forsevering and/or cauterizing all branches attached to the vessel. In theembodiment shown, the V-keeper 24 is advanced and retracted by aV-keeper button 26 on the handle 14. The V-cutter 25 is extended orretracted by manipulating a V-cutter extender button 27 on the handle14.

Also, in certain embodiments, as generally shown by referring to FIGS. 3and 3A along with FIG. 5, an endoscope wiper lever 28 is provided onhandle 14 for controlling a wiper 54 that clears the end of theendoscope 80 when the endoscope optics become covered by material in thebody cavity.

The handle 14 can be operatively attached to the electric cable 31 atone end for connecting to a source of high frequency voltage, andincludes conductors for supplying the voltage to electrodes on V-cutter25.

In certain embodiments, as shown in FIG. 2, the V-keeper 24 and theV-cutter 25 of the harvester tool 20 are in a generally parallelrelationship to each other within the dissector sheath 111. The V-keeper24 includes a guide 35 mounted to a support tool 36 and a movable pin37. The vein or other vessel to be harvested is maneuvered into anopening 38 and then the V-keeper buttons 26 on the handle 14 aremanipulated to extend the movable pin 37 to close the opening 38 andthereby retain the vessel. The V-cutter 25 includes a V-tip 40 mountedto an extendable guide 41 that is manipulated by the V-cutter button 27on the handle 14.

In use, when the vessel is being harvested, the vessel is retainedwithin the opening 38 in the V-keeper 24, which, in turn, is positionedwithin the tunnel or cavity that had previously been created during theblunt dissection. The V-cutter 25 is then moved to an extended position(not shown) for extending toward any vessel branches that might beattached to the vessel. The V-cutter 25 is then repeatedly engaged forsevering and cauterizing each branch to prepare the vessel for removal.

FIG. 3 shows the distal end of harvester tool 20 as extending from thedissector tool 11 in greater detail. The V-keeper 24 is longitudinallyextendable as shown by arrow K while the movable pin 37 is independentlylongitudinally extendable as shown by arrow P. As shown in FIG. 3, themovable pin 37 has been extended to the closed position used formaintaining the vessel being harvested within the opening 38.

The V-cutter 25 is longitudinally extendable in the directions shown byarrow C. FIGS. 2, 3, 3A and 5 show the V-cutter 25 retracted to itsinward position. While the embodiments shown in FIGS. 2 and 3 include anelongated sleeve 22 that contains both the V-keeper 24 and the V-cutter25, it is to be understood that the harvester tool 20 can be coaxiallypositioned within the sheath 111 of the dissector tool 11 without firstbeing axially aligned within the sleeve 22. For the embodiment shown inFIGS. 2 and 3, however, the sleeve 22 is shown. As such, the sleeve 22has a notch 50 with a terminal edge 51 that exposes the V-cutter 25prior to the V-cutter 25 being extended further than the end of sleeve22. A guard piece 52 is provided beneath the V-cutter 25. A lens portion53 at the end of the endoscope 80 is shown positioned near the distalend of sleeve 22.

In certain embodiments, the wiper 54 is mounted on a wiper shaft 54 a,as best seen in FIG. 6, for pivoting over the lens 53, as controlled bythe lever 28, to wipe away debris from the lens 53.

FIG. 4 shows the V-cutter 25 in greater detail. The V-cutter 25 includesa V-tip 40 that has angled surfaces 55 and 56 for guiding a blood vesselinto a longitudinal slit 57 having a terminus 58. An insulating basemember 60 carries an applying electrode 61 on one side and a feedbackelectrode 62 on the opposite side. When the blood vessel to be severedis passing perpendicularly through longitudinal slit 57, a highfrequency alternating voltage across electrodes 61 and 62 (from agenerator, not shown) generates localized heating which severs andcauterizes the vessel.

During an endoscopic procedure to harvest the blood vessel, theharvester tool 20 is axially displaced from the sheath 111. The V-cutter25 is extended and the electrodes are energized (e.g., by a foot pedal(not shown) operated by a surgeon) to individually sever the branchesfrom the blood vessel. The V-cutter 25 is then retracted to a positionlongitudinally inward from its cutting position while maintaining theV-keeper 24 remains in the extended and closed position.

Referring again to FIG. 5, in particular, one embodiment of a means foraxially displacing the harvester tool 20 with respect to the dissectortool 11 is shown. In the embodiment shown in FIG. 5, the harvester tool20 is displaced in a longitudinal direction out from the sheath 111 ofthe dissector tool 11. Again, it is to be understood that, in otherembodiments, other means are suitable for axially displacing either theharvester tool 20 or the dissector tool 11 with respect to each other.

In the embodiment shown in FIG. 5, a tube member 86 forms anendoscope-inserting channel within the sheath 111 along the axialdirection of the dissector/harvester device 10. The tube member 86extends from a base end of the handle 14 to the distal end of the sheath111. Within the handle 14, the V-cutter 25 is connected to the V-cutterbutton 27 by bipolar shafts 27 a and 27 b (as best seen in thecross-sectional view shown in FIG. 6). The V-cutter button 27 advancesand returns along the longitudinal axis of the handle 14. Then, theadvancing and returning force is transmitted to the V-cutter 25 via thebipolar shafts 27 a and 27 b.

Similarly, within the handle 14, the V-keeper 24 is connected to theV-keeper button 26 by V-keeper, shaft 26 a and V-keeper locking shaft 26b. The V-keeper button 26 advances and returns along the longitudinaldirection and the advancing and returning force is transmitted to theV-keeper 24 via the V-keeper shaft 26 a and V-keeper locking shaft 26 b.

For ease of illustration, the embodiment shown in FIG. 5 also caninclude a means 29 for axially displacing the dissector tool 11 withrespect to the harvester tool 20. It should be understood, however, thatin certain embodiments, both the harvester tool 20 and the dissectortool 11 do not both need to be axially moveable. That is, in certainembodiments, the harvester tool 20 is axially extendable beyond thedistal tip 113 of the sheath 111 of the dissector tool 11. In otherembodiments, the sheath 111 of the dissector tool 11 is retractable sothat the harvester tool 20 is exposed.

In certain embodiments, the harvester tool 20 is coaxially displacedwith respect to the dissector tool 11 and the harvester tool 20 isadvanced through a distal end of the dissector tool 11. In certain otherembodiments, the dissector tool 11 is coaxially displaced with respectto the harvester tool 20 and the dissector tool 11 is retracted alongthe harvester tool 20 to expose a distal end of the harvester tool 20.

Referring again to FIG. 5, within the handle 14, the sheath 111 isconnected to a dissector button 29 by a dissector shaft 29 a. Thedissector button 29 advances and returns along the longitudinaldirection and then the advancing and returning force is transmitted tothe dissector sheath 113 via the dissector shaft 29 a. In otherembodiments, the dissector button 29 can be connected directly to aproximal end 112 of the sheath 111 and can be operated to advance and/orretract the sheath 111.

In the embodiment shown in FIG. 5, the V-keeper button 26 and theV-keeper shaft 26 a and V-keeper locking shaft 26 b are integrally movedby a clicking mechanism 26 b. When the clicking mechanism 26 b is at anyof three clicking grooves 26 d in the handle 14, the V-keeper button 26and the V-keeper shafts 26 a and 26 b are stably kept. The V-keeperbutton 26 is detachably connected to a locking lever 26 e. When alocking button 26 f is pressed down, the V-keeper button 26 is separatedfrom the locking lever 26 e. The locking lever 26 e is connected to thelocking shaft 26 b. The locking lever 26 e advances and returns in theseparating state from the V-keeper button 26, thereby securing thevessel in the closed space 38 (refer to FIGS. 2 and 3). As mentionedabove, referring to FIGS. 2 and 3, the V-keeper button 26 advances andreturns, thereby advancing and returning the V-keeper 24 at its distalend.

Referring now to FIGS. 7-9, another embodiment of a unitarydissector/harvester device 200 is shown. For ease of illustration,similar elements will retain the same reference numerals. Referring nowin particular to the unitary dissector/harvester device 200, the unitarydissector/harvester device 200 generally includes a dissector tool 210and a coaxially aligned harvester tool 220, each of which will bedescribed separately in detail below.

The dissector tool 210 comprises an elongated sheath 211 having adissector tip 213 at its distal end 212. The sheath 211 defines an innerspace 215 for receiving the harvester tool 220. A proximal end 214 ofthe sheath 211 is operatively connected to a handle (not shown) andreceives an endoscope 80.

At least a portion of the dissector tip 213 is transparent in order toallow visualization of the vessel and the surrounding tissue. Uponinserting the dissecting tool 210 under the patient's skin, it ispossible to obtain an image illuminated by the illuminating light from afront end portion 81 of the endoscope 80.

In the embodiment shown in FIGS. 7-9, the dissector sheath 211 iscylindrical-shaped at its proximal end near the handle and has agenerally conical shaped tip 213. The dissector tip 213 has a taperededge 230 that includes a first opening 232 and a second opening 234. Thefirst opening 232 is configured to allow the V-keeper 24 to passtherethrough. Likewise, the second opening 234 is configured to allowthe V-cutter 25 to extend therethrough. While the first and secondopenings 232 and 234 can have generally similar dimensions, otherconfigurations are also possible. In the embodiment shown in FIGS. 8 and9, for example, the first opening 232 has a generally trapezoidal-shapedperimeter. The first opening 232 has a base 242 that circumferentiallyextends around a proximal end 216 of the tip 213. Opposing sides 244terminate at a top 246 that is adjacent to the distal end of the tip213.

The second opening 234 has a base 252 that circumferentially extendsaround a proximal end 216 of the tip 213. Opposing sides 254 terminateat a top 256 that is adjacent to the distal end 212 of the dissector tip213.

Also, in certain embodiments, as shown in phantom in FIG. 8, thedissector tip 213 can include a first lid or closure 248 that extendsover the first opening 232. In certain embodiments, the closure 248 canbe transparent. The closure 248 can be operatively secured to the sheath211 in a suitable manner. In certain embodiments, the closure 248 can besecured to the sheath 211 by a hinge 249 that extends along the base 242of the first opening 232. For example, a “living” hinge 249 can beformed along at least a part of the base 242 of the first opening 232.

Similarly, in certain embodiments, also as shown in FIG. 8, thedissector tip 213 can include a second lid or closure 258 that extendsover the second opening 234. The closure 258 can be operatively securedto the sheath 211 in a suitable manner. In certain embodiments, theclosure 258 can be secured to the sheath 211 by a hinge 259 that extendsalong the base 252 of the second opening 234. For example, a “living”hinge 249 can be formed along at least a part of the base 252 of thesecond opening 234.

In certain embodiments, the dissector sheath 211 can include one or moredischarge ports or holes 235 that are in communication with an innerspace 215 of the sheath 211 to allow gas to enter the forming cavity andto keep surrounding tissue from the unitary dissector/harvester device200. In other embodiments, the holes 235 are not needed, and the gas canescape into the surrounding tissue though gaps defined by the perimetersof the openings 232 and 234 and the corresponding closures 248 and 258,respectively.

In a similar manner to the above-described procedure, to begin thedissection procedure, the dissector tip 213 is inserted through thetrocar (not shown) that has been positioned within an initial incisionin the patient. In operation, the dissector tip 213 is pressed into thetissues surrounding the vessel, thereby forming a tunnel or cavityaround the blood vessel. In certain embodiments, it is desired that thedissector tip 213 be pressed into the surrounding tissue generally alongthe direction of the vessel in order to separate the vessel fromadjacent tissue without damage to the surrounding tissue.

In certain embodiments, the insufflation tube (not shown) may beconnected to a source of gas (e.g., CO₂) for filling the cavity adjacentthe vessel as the cavity is being formed. In such embodiments, thedissector tool 210 is airtightly connected to the handle.

The dissector tool 210 is advanced through the patient's tissue, formingthe cavity or tunnel around the blood vessel. The dissector tool 210 isthus used to perform an initial, or blunt, dissection of the vessel.

After the initial blunt dissection around the vein by the dissector tool210, the coaxially aligned harvester tool 220 is engaged to “harvest” orremove the bluntly dissected vessel. The harvester tool 220 is engagedto grasp the vessel being dissected and to sever any branches orconnective tissue connecting to the vessel.

The harvester tool 220 is coaxially displaced from the dissector tool210 through the first opening 232. In the embodiment shown in FIGS. 7-9,the harvester tool 20 is advanced past the distal end 212 of thedissector tip 213.

The harvester tool 20 is coaxially aligned within the sheath 211 of thedissector tool 210. As described above, and shown in phantom in FIG. 8,the harvester tool 20 includes the V-keeper 24 and the V-cutter 25. Inthe embodiment shown, the V-keeper 24 is advanced and retracted throughthe first opening 232 and the V-cutter 25 is extended or retractedthrough the second opening 234.

In certain embodiments, as shown in FIGS. 7-9, the V-keeper 24 and theV-cutter 25 of the harvester tool 20 are in a generally parallelrelationship to each other within the dissector sheath 211. The V-keeper24 is longitudinally extendable in the directions shown by arrow K andthe V-cutter 25 is longitudinally extendable in the directions shown byarrow C.

Referring now to FIGS. 10A and 10B and 11A and 11B, another embodimentof a unitary dissector/harvester device 300 is shown. For ease ofillustration, similar elements will retain the same reference numerals.Referring now in particular to the unitary dissector/harvester device300, the unitary dissector/harvester device 300 generally includes adissector tool 310 and a coaxially aligned harvester tool 320.

The dissector tool 310 comprises an elongated sheath 311 having adissector tip 313 at its distal end 312. The sheath 311 defines an innerspace 315 for receiving the harvester tool 320. A proximal end 314 ofthe sheath 311 is operatively connected to a handle (not shown) andreceives an endoscope.

Upon inserting the dissector tool 310 under the patient's skin, it ispossible to obtain an image illuminated by the illuminating light from afront end portion of the endoscope.

In the embodiment shown in FIGS. 10 and 11, the dissector sheath 311 iscylindrical-shaped at its proximal end near the handle and has agenerally conical shaped tip 313.

The dissector tip 313 has several circumferentially extending closures330. As best seen in the embodiment shown in FIG. 10B, the dissector tip313 includes four (4) generally triangularly shaped closures 330. Theclosures 330 are configured to allow the harvester tool 320 to passtherethrough. While there are four closures 330 shown that havegenerally similar dimensions, in other embodiments, other numbers andconfigurations of closures 330 are also possible. In the embodimentshown in FIGS. 10 and 11, for example, the closures 330 generally have atriangular perimeter such that the closure itself has a quarter conicalshape. In the embodiment shown, each closure 330 has a base 342 thatcircumferentially extends around a portion of a proximal end 316 of thetip 313. Opposing sides 344 terminate at a top 346 that is adjacent tothe distal end of the tip 313.

Also, in certain embodiments, as shown in FIG. 10B, the top 346 of theclosure 330 can define an opening 347 such that light and/or images canbe sent and received through the endoscope 80. In such embodiments, itis not necessary that the tip 313 be made of a transparent material.

The closures 330 can be operatively secured to the sheath 311 in asuitable manner. In certain embodiments, the closure 330 can be securedto the sheath 311 by a hinge 349 that extends along the base 342 of thetip 313. For example, a “living” hinge 349 can be formed along at leasta part of the base 342. In such embodiments, the hinge 349 providessufficient flexibility to the closure 330 so that advancement of theharvester tool 320 through the tip 313 pushes the closures 330 to anopen position, as schematically illustrated in FIGS. 11A and 11B.

In other embodiments, the tip 313 can be fixed to the distal end of thesheath 311 and the closures 330 can have sufficient flexibility that theclosures 330 are moved in a generally radially outward direction as theharvester tool 320 is advanced in a longitudinal direction through thedissector tip 313, as schematically illustrated in FIG. 11A.

In certain embodiments, the dissector sheath 311 can include one or moredischarge ports or holes 335 that are in communication with the innerspace 315 of the sheath 311 to allow gas to enter the forming cavity andto keep surrounding tissue from the unitary dissector/harvester device310. In other embodiments, the holes 335 are not needed, and the gas canescape into the surrounding tissue though gaps defined by spaces betweenadjacent closures 330.

In a similar manner to the above-described procedure, to begin thedissection procedure, the dissector tip 313 is inserted through thetrocar (not shown) that has been positioned within an initial incisionin the patient. In operation, the dissector tip 313 is pressed into thetissues surrounding the vessel, thereby forming a tunnel or cavityaround the blood vessel. In certain embodiments, it is desired that thedissector tip 313 be pressed into the surrounding tissue generally alongthe direction of the vessel in order to separate the vessel fromadjacent tissue without damage to the surrounding tissue.

In certain embodiments, the insufflation tube (not shown) may beconnected to a source of gas (e.g., CO₂) for filling the cavity adjacentthe vessel as the cavity is being formed. In such embodiments, thedissecting tool 311 is airtightly connected to the handle.

The dissector tool 311 is advanced through the patient's tissue, formingthe cavity or tunnel around the blood vessel. The dissector tool 311 isthus used to perform an initial, or blunt, dissection of the vessel.

After the initial blunt dissection around the vein by the dissector tool311, the coaxially aligned harvester tool 320 is engaged to “harvest” orremove the bluntly dissected vessel. The harvester 320 is engaged tograsp the vessel being dissected and to sever any branches or connectivetissue connecting to the vessel.

The harvester tool 320 is coaxially aligned within the sheath 311 of thedissector tool 311. The harvester tool 320 is coaxially displaced fromthe dissector tool 311 through the dissector tip 313. In the embodimentshown in FIGS. 10A-11B, the harvester tool 320 is advanced past thedistal end 312 of the dissector tip 313.

In certain embodiments, the dissector/harvester device 10 can beincluded in a kit along with a trocar in order to make both thedissector/harvester device 10 and/or the trocar easy to use and disposein a safe manner.

In accordance with the provisions of the patent statutes, the principleand mode of operation of this invention have been explained andillustrated in its preferred embodiment. However, it must be understoodthat this invention may be practiced otherwise than as specificallyexplained and illustrated without departing from its spirit or scope.

1. A unitary endoscopic device for dissecting and harvesting a vesselcomprises an elongated dissector tool for insertion into a body having avessel to be harvested, and a harvester tool axially positioned withinthe dissector tool.
 2. The device of claim 1, wherein the harvester toolis coaxially displaced with respect to the dissector tool.
 3. The deviceof claim 2, wherein the harvester tool is advanced through a distal endof the dissector tool.
 4. The device of claim 1, wherein the dissectortool is coaxially displaced with respect to the harvester tool.
 5. Thedevice of claim 4, wherein the dissector tool is retracted from theharvester tool.
 6. The device of claim 1, further including an endoscopeco-axially positioned within the dissector tool.
 7. The device of claim1, wherein the dissector tool includes a sheath having a dissector tip,the dissector tip being configured for separating peripheral tissue fromthe vessel being harvested.
 8. The device of claim 7, wherein thedissector tip includes at least one closure at a distal end thereof. 9.The device of claim 8, wherein the dissector tip is defined by anoblique plane extending through a distal end of the sheath.
 10. Thedevice of claim 7, wherein the dissector tip has a conical shape,wherein the conical shape includes at least one opening configured toallow the harvester tool to be displaceable with respect the dissectortip.
 11. The device of claim 10, wherein the harvester tool is advancedpast the distal tip.
 12. The device of claim 1, wherein the harvestertool comprises: i) a cutter longitudinally displaceable with respect tothe dissector tool toward a cutting position for cutting a branch of avessel being harvested; and, ii) a keeper longitudinally displaceablewith respect the dissector tool toward a keeping position for securingthe vessel being harvested while the branch is being cut.
 13. The deviceof claim 12, wherein the cutter comprises a cutter tip and alongitudinal slit for receiving a branch to be cut, the cutter furthercomprising electrodes adjacent to the longitudinal slit for beingelectrically energized to cut and cauterize the branch.
 14. The deviceof claim 1, wherein the dissector tool defines an inner space configuredto receive the harvester tool and an endoscope.
 15. A method of severingbranches from a vessel during harvesting from a body by a unitaryendoscopic device, the device having an elongated dissector tool forinsertion into the body having the vessel to be harvested, and aharvester tool axially positioned within the dissector tool, the methodcomprising the steps of: inserting the endoscopic device into the bodyalongside the vessel to form a cavity substantially surrounding thevessel; and, engaging the harvester tool to secure the vessel and toindividually sever any branches attached to the vessel.
 16. The methodof claim 15, wherein the harvester tool is coaxially displaced withrespect to the dissector tool.
 17. The method of claim 16, wherein theharvester tool is advanced through a distal end of the dissector tool.18. The method of claim 15, wherein the dissector tool is coaxiallydisplaced with respect to the harvester tool.
 19. The method of claim18, wherein the dissector tool is retracted from the harvester tool. 20.A method of severing branches from a vessel during harvesting from abody by a unitary endoscopic device, the device having an elongateddissector tool for insertion into the body having the vessel to beharvested, and a harvester tool positioned within the dissector tool;the harvester tool comprising i) a cutter longitudinally displaceablewith respect to the dissector tool toward a cutting position for cuttinga branch of a vessel being harvested; and, ii) a keeper longitudinallydisplaceable with respect the dissector tool toward a keeping positionfor securing the vessel being harvested while the branch is being cut;the method comprising the steps of: inserting the endoscopic device intothe body alongside the vessel to form a cavity substantially surroundingthe vessel; extending the keeper to secure the vessel; extending thecutter and energizing the electrodes to individually sever any branchesattached to the vessel; and, retracting the cutter to a positionlongitudinally inward from the cutting position while maintaining thevessel within the keeper.